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At least 469 records · Page 26Linked to original sources
PubMed2000

Guided tissue regeneration procedure with bioresorbable membranes versus conventional flap surgery in the treatment of infrabony periodontal defects.

AIM: Claims are being made that clinical results of periodontal flap surgery are enhanced when membranes are employed to aid GTR in intrabony pockets. It was the aim of our study to determine whether this assumption was true for a certain bioresorbable membrane (Guidor Matrix Barrier). METHOD: 44 intrabony defects were treated in 16 patients. In 21 lesions, conventional flap surgery only was performed, while in 23, similar lesion membranes were placed as an additional treatment task. Results were evaluated over a time span of 12 months. RESULTS: In all surgical areas, treatment resulted in significant improvement of parameters such as attachment levels and probing depths, as well as index values for plaque and bleeding on probing. This occurred whether membranes had been used or not, without any significant differences when comparing the collective results of both treatment groups. CONCLUSIONS: Placement of membranes during periodontal surgery for the enhancement of tissue regeneration in intrabony pockets is often both difficult and time consuming. In the light of our clinical results with resorbable membranes, such extra effort seems hardly warranted.

Adult↗
PubMed1993

Perception of risk of HIV infection from regular attenders to an industrial dental service.

The advent of the HIV pandemic has necessitated the introduction of consistent cross-infection procedures for dentistry. Suprisingly little is known of patient reactions to some of these changes. A structured questionnaire was administered (in 1988/9, n = 613) to regular-attending patients of an industrial dental service to assess their views towards cross-infection procedures. Approximately a third of the study sample believed that there was a slight risk or more of contracting HIV infection at the dentist. This risk perception attenuated with further visits to the dentist. Some patients (13%) claimed to be aware from the media of someone having been cross-infected with the HIV virus from a dental visit. The majority of patients prefer the dentist to adopt the barrier methods of mask and glove wearing. Over 60% of patients would like their dentist to wear a mask when in fact a mask had not been worn. Accuracy of recall by patients for mask wearing was only 70% and for glove wearing 88%. The possibility that drawing the patient's attention to cross-infection control may be reassuring for the patient was not supported with some evidence to suggest that in instances where the dentist provided treatment, the patient's perception of risk was increased.

Adolescent↗
PubMed1998

Medical practices regarding hepatitis C virus infection in Europe.

Six hundred and ninety-three European Association for the Study of the Liver (EASL) members, belonging to one of the 15 European Union (EU) member-states, were surveyed, through a standardized 45-item questionnaire, on their medical practices regarding hepatitis C virus (HCV) infection. The response rate was 45%, roughly similar in all the countries concerned. Responders were classified into three groups according to their geographical origin: North, Centre and South. A consensus existed with regard to the necessity of HCV screening in well-defined situations, such as history of blood transfusion, haemodialysis, haemophilia or intravenous drug addiction (90% of positive answers) while opinions substantially differed for vertical and nosocomial transmission of HCV. For the prevention of sexual and vertical transmission, opinions differed greatly: 22% were in favour of barrier methods for HCV-positive subjects while 34% were against; 49% allowed breast-feeding for babies born to HCV-positive mothers while 14% were against. Conversely, there was relative homogeneity in the issue of domestic prevention (70% in favour of precautions). Algorithms for prescription of virological tests were inhomogeneous (recombinant immunoblot assay was used by 60%; polymerase chain reaction was requested by 77% when alanine amino-transferase (ALT) was elevated vs 89% when normal): medical evaluation varied according to ALT values: liver biopsy and liver ultrasonography were carried out in 90 and 91% vs 40 and 70% for increased and normal ALT, respectively. Thirty per cent of respondents advised patients to stop alcohol consumption and 60% advised moderation. Two-thirds of the responders did not take into account histological severity and virological parameters before initiating antiviral therapy. Eighty per cent of the participants claimed that they administered interferon (IFN) for 12 months. For most of the items studied, there was a large variation, not only between the three groups, but also within each group. Ninety-two per cent of the responders claimed that they were well trained on HCV but they were rather critical of the quality of the information diffused (satisfaction rate: 45%). Altogether, our survey demonstrates that preventive and medical practices towards HCV are not homogeneous throughout the EU; this suggests the need for a European consensus conference in this regard.

Europe↗
PubMed2002

Patterns of nephrin and a new proteinuria-associated protein expression in human renal diseases.

BACKGROUND: Many factors contribute to the pathogenesis of glomerular proteinuria, but no exact molecular mechanisms are known to date. The recently reported protein nephrin, encoded by the NPHS1 gene, appears to be crucial for the integrity of the glomerular filtration barrier. METHODS: Immunohistochemistry was used to detect possible changes in glomerular nephrin, and a new proteinuria-associated protein expression was developed in various diagnostic groups of human kidney biopsies. RESULTS: In normal control kidney, antibodies to intracellular and extracellular nephrin domain showed a typical podocyte pattern of reactivity, while the 18C7 antibody to a normally inaccessible proteinuria-associated epitope was negative. Instead, strong glomerular positivity by 18C7 was seen in membranous glomerulonephropathy, membranoproliferative glomerulonephritis, systemic lupus erythematosus and cryoglobulinemic nephritis, while with antibodies to either intracellular or extracellular nephrin domains, a down-regulation in nephrin expression pattern was shown. CONCLUSIONS: Unmasking or de novo expression of distinct glomerular proteins may be an important feature reflecting the pathophysiological events in these diseases with altered glomerular permeability, while only mild changes in the slit diaphragm protein nephrin appear to take place.

Amino Acid Sequence↗
PubMed1990

[Prevention of HIV infections in surgical gynecology and obstetrics].

In professionally conditioned HIV infections of medical personnel, blood has so far been the only source of infection that is of any importance. Hence, measures to prevent such infections must primarily aim at avoiding any contact with blood from HIV-infected patients. Since the HIV status of the patients and possibly alos other infections transmitted by blood (hepatitis) are often unknown, the following protective measures must be applied in all patients as a matter of routine. Fundamentally, gloves must always be worn when coming into contact with blood, body fluids, mucosa and non-intact skin. In operative procedures and deliveries, barrier methods must be employed to protect the eyes, nose, mouth and skin, as well as technical procedures during surgery and organisational measures to prevent any possible injuries or lesions caused by operative interventions and to reduce the number of persons exposed to risk. So far, needle pricks have been the most frequent mode of infection. Hence, used cannules should be treated with utmost care; do not return them into their protective cover but throw them directly into solid waste containers. After contamination, blood and other body fluids should be eliminated immediately. In case of massive contamination with material containing HIV, chemoprophylaxis should be given careful consideration.

Cesarean Section↗
PubMed1990

Readability of commercial versus generic health instructions for condoms.

Despite the fact that condoms are increasingly recommended for the prevention of acquired immune deficiency syndrome (AIDS) and other sexually transmitted diseases (STDs) and have long been used as a barrier method of contraception, little is known about the readability of the range of materials that have been written exclusively for consumers on how to use a condom. The authors described and compared the reading comprehension levels of condom patient package inserts (PPIs) prepared commercially and those generic instructions (GIs) prepared by health care providers. Fifteen sets of PPIs and 30 sets of GIs were analyzed using six standard readability formulas (Fry, Fog, Dale-Chall, Flesch, Flesch-Kincaid, SMOG). Readability levels of the instructions ranged from grade 6.3 to 13.7. The PPIs required a significantly higher grade level for comprehension (mean 10.32) than the GIs (mean 8.69). This study suggests that instructions prepared by both sources may require a reading level above that of many consumers who need information on how to use a condom.

Contraceptive Devices, Male↗
PubMed1995

Inconsistent contraceptive use among female college students: implications for intervention.

The authors evaluated the longitudinal consistency of use of contraceptive and barrier methods among female college students attending a student health clinic. The majority of students using unreliable methods of contraception during follow-up did not report unreliable contraceptive use at the baseline observation. Of 213 women who participated, 33% used unreliable contraception; 9% only at baseline, 14% only during 6-month follow-up, and 9% at both. Selection of a contraceptive method varied considerably over time. Of those using the oral contraceptive pill at baseline, 31% did not use this method during follow-up, and 43% of those using condoms at baseline had intercourse without a condom during follow-up. Single observations are inadequate to detect unreliable contraceptive use in this population; cross-sectional studies will fail to detect important transitions in contraceptive use. Interventions to prevent pregnancy and sexually transmitted disease among female college students should include a focus on the consistency of contraceptive use.

Adult↗
PubMed2001

Breast cancer screening among Hmong women in California.

BACKGROUND: Breast cancer is the leading cause of cancer incidence and mortality among Asian American and Pacific Islander (AAPI) women in the United States. Hmong women are among those at the highest risk for health problems, due to high rates of poverty, language isolation, and cultural barriers. METHOD: One-on-one survey interviews were completed with 201 Hmong women aged 20 years and older in Fresno, Long Beach, Orange County, and San Diego to determine their breast cancer screening behaviors--breast self-examination (BSE), clinical breast examination (CBE), and mammography. RESULTS: Overall, 51% of all respondents had ever performed BSE. Among respondents aged 40 or older, 52% had ever had a CBE and only 30% had ever had mammography. DISCUSSION: Significant correlates of CBE and mammography screening are presented, and implications of findings for research and education are discussed.

Adult↗
PubMed2003

Rehabilitation research from a non-English speaking country published in peer-reviewed English journals--the Japanese experience.

PURPOSE: To study the status of contribution by non-English speaking countries to international rehabilitation literature taking Japan as an example, and to suggest recommendations to overcome the language barrier. METHOD: Descriptive study using a systematic MEDLINE search with outcome measures of annual numbers and proportions of articles by Japanese physiatrists published in peer-reviewed English rehabilitation journals, and of categories and types of studies. A database containing 292 relevant articles were used for analysis. RESULTS: The publications have steadily increased annually both in absolute number and in proportion. The number was the largest for Arch Phys Med Rehabil (16.8%), followed by Am J Phys Med Rehabil (12.3%), Prosthet Orthot Int (8.6%), Disabil Rehabil (5.1 %) and so on. The percentage by category was the highest for stroke (26.0%), followed by spinal cord injury (11.6%), neurophysiology (11.6%) and amputation (6.2%), 67.8% of the articles were related to evaluation, 6.5% to outcome studies and 25.7% to therapy. The majority were descriptive studies (45.5%), followed by case control studies (13.0%), before-and-after trials (12.3%), case reports (7.2%) and others. CONCLUSION: The contribution from Japan to international rehabilitation literature is increasing. Measures were suggested to facilitate more scientific contribution by non-English speaking researchers.

Humans↗
PubMed2005

Antimicrobial peptides as microbicidal contraceptives: prophecies for prophylactics--a mini review.

The global increase in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and sexually transmitted infections (STIs) has led to the introduction of barrier methods, such as condoms. However, drawbacks associated with condoms, such as men being reluctant to use them and women being unable to negotiate their use, have led to the search for better and acceptable alternatives, namely the microbicides. These are gel formulations that, when used prior to sexual intercourse, protect against the transmission of HIV and other STIs. However, after observing the side-effects of nonoxynol-9, a component of the microbicidal formulations available on the market, the focus has shifted to natural available compounds demonstrating the preferred protective effects. Antimicrobial peptides (AMPs) are one such group of compounds present in a wide range of organisms from bacteria to humans. The existing 750 or so, low-molecular-weight, cationic charged peptides are classified into five major groups based on their three-dimensional structure obtained by nuclear magnetic resonance studies. The hypothesized mode of action seems to be the interaction of the positively charged peptides with the negatively charged phospholipids present on the surface of the cell membrane. Various studies have demonstrated the effect of several AMPs, namely, defensins, protegrins, cathelicidins, cecropins, polyphemusins, magainins and melittins, against various STI-causing pathogens and HIV/herpes simplex virus, both in vitro and in vivo. The contraceptive efficacies of magainin and nisin in vitro and in vivo are worth mentioning. We believe these peptides are suitable candidates in the development of newer mechanism-based microbicides in future.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Reducing occupational risk of HIV infection.

At San Francisco General Hospital and many other institutions in areas of high HIV prevalence, a policy of body substance isolation has proved easier to implement than the CDC's across-the-board recommendations. Prevention of needle-stick injury and use of barrier methods of infection control are emphasized. Preoperative HIV testing is addressed.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Estimating cycle pregnancy probability with incomplete data in contraceptive studies.

In studies on the effectiveness of barrier method contraceptives, researchers need to estimate the risk of pregnancy during consistent use of these methods. However, participants may not use assigned methods consistently, and only consistent-use cycles are included in the estimates. Inconsistent-use cycles are considered missing intervals, and a subject's early discontinuation from the study or pregnancy during inconsistent use is censored from the analysis. In this article, we consider a semiparametric maximum likelihood approach to estimate survival probability for grouped survival data with missing and censored data. The method is flexible in that it is nonparametric with respect to the underlying survival function, yet it can be easily extended to accommodate the covariates in a parametric way. Results from our simulation study show that the proposed method works well in practical sample sizes. Our findings support the U.S. Food and Drug Administration's (FDA) sample size requirements for contraceptive studies. We use data from an effectiveness trial on vaginal contraceptive film (VCF) to illustrate the proposed methods.

Clinical Trials as Topic↗
PubMed1996

Ovulation induction using s.c. pulsatile gonadotrophin-releasing hormone: effectiveness of different pulse frequencies.

To determine the ovarian response to a fixed dose of gonadotrophin-releasing hormone (GnRH) administered s.c. at four different pulse frequencies, 20 patients with hypothalamic amenorrhoea were treated over 41 cycles using a dose of 20 ng/kg/pulse. These patients were randomly assigned to receive GnRH at pulse frequencies of 60, 90, 120 or 180 min. GnRH was administered s.c. using portable infusion pumps. Subjects were paid volunteers with a diagnosis of hypothalamic amenorrhoea. All patients had low to less than detectable serum concentrations of luteinizing hormone and follicle stimulating hormone on 8 h serial sampling, and normal serum concentrations of prolactin and androgen, including androstenedione, testosterone and dihydroepiandrosterone sulphate. Six of the 20 patients were enrolled in the protocol to achieve a pregnancy, while 14 were volunteers using a barrier method of contraception. Highest ovulation rates were achieved using pulse frequencies of 90 and 120 min (60 and 88% of cycles respectively). Ovulation occurred significantly less often with frequencies of 60 and 180 min (12 and 38% respectively; P </= 0.05). Pregnancy was achieved in four of the six patients who desired a pregnancy at pulse frequencies of 90 (three out of three) and 120 (one out of one) min. No pregnancies occurred at pulse frequencies of 60 (none out of one) and 180 (none out of one) min. When ovulatory cycles were considered, oestradiol concentrations were not different among pulse frequencies but varied significantly between ovulatory and anovulatory cycles. Integrated luteal progesterone concentrations for 90 and 120 min frequencies (118.26 +/- 25.89 and 125.15 +/- 32. 10 ng/ml/luteal phase respectively) were significantly higher than for 60 and 180 min (80.1 +/- 48.2 and 42.75 +/- 26.48 ng/ml/luteal phase respectively). Ovulation may be induced by a broad range of pulse frequencies. Pulse frequencies of 90 or 120 min for s.c. GnRH appear to induce more reliably the sequence of follicular development, ovulation and normal luteal function than frequencies of either 60 or 180 min. Significantly higher ovulation rates occurred at 90 and 120 min by s.c. administered GnRH.

Adult↗
PubMed2001

Two new male contraceptives exert their effects by depleting germ cells prematurely from the testis.

The three currently available male contraceptive approaches are 1) the barrier method such as the condom, 2) hormonal methods by disrupting the pituitary-testicular axis so as to impair spermatogenesis, and 3) immunological methods by preparing vaccines against male-specific antigens. We hereby describe an alternative approach in which attachments of developing germ cells onto the seminiferous epithelium are disrupted, thereby inducing their premature release into the tubular lumen. This in turn leads to infertility. A panel of analogues based on the core structure of 1-(2,4-dichlorobenzyl)-indazole-3-carboxylic acid was synthesized. These compounds were subjected to an in vivo screening assay assessing their effects in inducing the expression of testin, a testicular marker whose expression correlates with the integrity of Sertoli-germ cell junctions. An induction of testin expression in the testis signifies a disruption of Sertoli-germ cell junctions that is followed by depletion of germ cells from the seminiferous epithelium. Two compounds, namely 1-(2,4-dichlorobenzyl)-indazole-3-carbohydrazide (AF-2364) and 1-(2,4-dichlorobenzyl)-indazole-3-acrylic acid (AF-2785), were identified that caused detachment of germ cells, in particular round and elongated spermatids, from the epithelium inducing their premature release into the tubular lumen as confirmed by histological analysis. Adult rats receiving several oral doses of either one of these compounds became infertile within 3-7 wk after the epididymal sperm reserve was exhausted. Depending on the dosing of the administered compound, rats became infertile for 4-14 wk before their fertility gradually bounced back, illustrating the reversibility and efficacy of these new compounds. Also, these compounds did not appear to impair the hypothalamus-pituitary-testicular axis because the serum levels of LH, FSH, and testosterone of the treated animals did not change significantly when compared to control rats. In addition, results of serum microchemistry illustrate that liver and kidney function was not affected in animals treated with both compounds.

Animals↗
PubMed1997

Opioid-induced delay in gastric emptying: a peripheral mechanism in humans.

BACKGROUND: Opioids delay gastric emptying, which in turn may increase the risk of vomiting and pulmonary aspiration. Naloxone reverses this opiate action on gastric emptying, but it is not known whether this effect in humans is mediated by central or peripheral opiate antagonism. The importance of peripheral opioid receptor antagonism in modulating opioid-induced delay in gastric emptying was evaluated using methylnaltrexone, a quaternary derivative of the opiate antagonist naltrexone, which does not cross the blood-brain barrier. METHODS: In a randomized, double-blind, crossover placebo-controlled study, 11 healthy volunteers were given either placebo (saline), 0.09 mg/kg morphine, or 0.09 mg/kg morphine plus 0.3 mg/kg methylnaltrexone on three separate occasions before ingesting 500 ml deionized water. The rate of gastric emptying was measured by two methods: a noninvasive epigastric bioimpedance technique and the acetaminophen absorption test. RESULTS: The epigastric bioimpedance technique was sufficiently sensitive to detect opioid-induced changes in the rate of gastric emptying. The mean +/- SD time taken for the gastric volume to decrease to 50% (t0.5) after placebo was 5.5 +/- 2.1 min. Morphine prolonged gastric emptying to (t0.5) of 21 +/- 9.0 min (P < 0.03). Methylnaltrexone given concomitantly with morphine reversed the morphine-induced delay in gastric emptying to a t0.5 of 7.4 +/- 3.0 (P < 0.04). Maximum concentrations and area under the concentration curve from 0 to 90 min of serum acetaminophen concentrations after morphine were significantly different from placebo and morphine administered concomitantly with methylnaltrexone (P < 0.05). No difference in maximum concentration or area under the concentration curve from 0 to 90 min was noted between placebo and methylnaltrexone coadministered with morphine. CONCLUSIONS: The attenuation of morphine-induced delay in gastric emptying by methylnaltrexone suggests that the opioid effect is mediated outside the central nervous system. Methylnaltrexone may have the potential to decrease the side effects of opioid medications, which are mediated peripherally, while maintaining the central analgesia effect of the opioid.

Acetaminophen↗
PubMed1993

Increased bile duct complications in liver transplantation across the ABO barrier.

OBJECTIVE: This study evaluated the outcome of liver grafts from ABO incompatible donors, focusing on biliary complications, and compared the results to an ABO compatible control group. Also, the expression of donor ABH antigens in the liver graft was analyzed. SUMMARY BACKGROUND DATA: The outcome of liver transplantation using an ABO incompatible graft is still debated. These blood group related (ABH) antigens are known to be expressed not only on the surface of the erythrocytes, but also on the epithelial cells of large bile ducts. Because the biliary epithelium of hepatic allografts may continue to express donor ABH antigens, it may be more susceptible to immunologic bile duct injury after transplantation across the ABO barrier. METHODS: Eighteen ABO incompatible grafts were compared with 18 ABO compatible grafts in patients who were matched according to medical urgency, primary liver disease (PLD), and recipient age. After transplantation, the grafts were analyzed with cholangiography, Doppler ultrasound, or arteriography and liver histology according to protocol. Immunoperoxidase staining for ABH antigens was performed on hepatic tissue. RESULTS: Biliary complications developed in 82% of the ABO incompatible donors, compared to 6% of the ABO matched controls. Hepatic artery thrombosis occurred in 24%. Cellular rejection was diagnosed in 65% versus only 28% in the control group. The 1-year actuarial graft survival rate was 44% versus 78% in the control group. ABH antigens of the donor were expressed on vascular endothelium and bile duct epithelial cells as long as 150 days after transplant. CONCLUSIONS: Using ABO incompatible allografts, a high incidence of biliary and hepatic artery complications and decreased graft survival in liver transplantation were found. An immunologic injury to the bile duct epithelium and/or to vascular endothelium is suspected.

ABO Blood-Group System↗
PubMed1994

Epidemiology of pelvic inflammatory disease.

The epidemiologic study of pelvic inflammatory disease (PID) is hindered by symptoms that differ substantially from case to case, and by a substantial number of "silent" cases with few or no symptoms. Demographic data indicate that PID is primarily a disease of the young. Race also appears to be a determinant, but whether for biologic or sociologic reasons is not known. Women who are not married face a greater risk for PID than married women. The majority of PID cases are associated with sexually transmitted diseases. Consistent with this finding is the pattern of risk factors related to sexual behavior: young age at first intercourse, high frequency of intercourse, and a large number of sexual partners all increase the risk of PID. On the other hand, barrier methods of contraception appear to reduce the risk of PID, as does oral contraception. Perhaps the best publicized risk factors for PID is another contraceptive, the intrauterine device (IUD). The increased risk of PID in IUD users appears to be confined to new users and women at high risk of sexually transmitted disease infection. Douching and cigarette smoking may also be associated with the development of PID, but the evidence is weak.

Adolescent↗
PubMed2002

Assessing quality and costs of education in the ambulatory setting: a review of the literature.

PURPOSE: Time-pressured interactions with little direct observation or feedback characterize teaching in ambulatory settings. The authors report findings from the literature on teaching and learning in the ambulatory setting and propose opportunities for further research that addresses these barriers. METHOD: The authors searched 1995-1999 databases for all empirical studies that focused on research conducted in ambulatory settings. Publications were reviewed for evidence of inclusion criteria. Findings were sorted into categories previously described for defining and evaluating quality of ambulatory care educational programs. RESULTS: Most studies were conducted in departments of internal medicine (40%), focused on medical students (43%), and took place in a single program (77%), making generalizations difficult. Students and residents are learning in ambulatory environments, and the types of patients they encounter are likely to prepare them for practice. Patient care outcomes have emerged as a measure of learning. Teachers may be the single most important factor, yet they lack self-confidence as teachers. Community-based preceptors teach because of enjoyment of teaching and the opportunity to stay current. However, none of the studies addressed the impact of the Medicare documentation requirements on satisfaction with teaching. Teaching settings cost about one third more than non-teaching settings to operate. CONCLUSION: This review identifies many gaps in our knowledge of effective clinical teaching practices, and of learning environments in which that teaching takes place. The predominance of single-institution studies limits generalizability of current findings. A prioritized research agenda should be established and funded, focusing on improving the efficiency and effectiveness of teaching and learning in ambulatory settings.

Ambulatory Care↗